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Fungal Infections among Returning Travelers

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Overview

Endemic mycosis is emerging as an important health threat among travelers to areas of the world that are home to this infection. Travelers develop a fungal infection as a result of a wide range of leisure and work activities, which have known risk factors that contribute to fungal infections. In this article, we will discuss the four most important types of fungal infections that threaten the health of travelers, their symptoms, and methods of treatment.

Most common endemic mycoses among Returning Travelers

1- Blastomycosis:  is an infection caused by the Blastomyces fungi that live in moist soil and decomposing organic matter such as wood and leaves. Blastomyces live mainly in the Midwest, South Central, and Southeast states of the United States, particularly in the areas around the Ohio Valleys and the Mississippi River. It also lives in Canada, and a few cases of Blastomycosis have been reported in Africa and India.  This fungal infection is transmitted to people by inhaling microscopic fungal spores from the air, often after performing soil-moving activities. The infection can become severe in people with weakened immune systems, especially if it spreads from the lungs to other organs

  • 2 – Cryptococcosis:  is a disease that usually affects the lungs or central nervous system (brain and spinal cord) caused by the fungus Cryptococcus gattii (C. gattii) that lives in soil and on some trees, especially in tropical and subtropical regions around the world. People can become infected with C. gattii after inhaling the microscopic fungi from the environment. Cryptococcal meningitis is a brain infection caused by C. gattii and other types of Cryptococcus after the infection spreads from the lungs to the brain.

3- Paracoccidioidomycosis: is an infection caused by the fungus Paracoccidioides. This fungus lives in parts of Central and South America. Anyone who lives in or visits areas where Paracoccidioides lives can get paracoccidioidomycosis, but it most often affects men who work outdoors in rural areas.

4- Histoplasmosis: is an infection caused by Histoplasma fungi that live in soil containing large amounts of bird or bat droppings. Histoplasma lives mainly in the central and eastern states of the United States, especially the areas around the Ohio Valleys and the Mississippi River. Mushrooms also live in Africa, Asia, and Australia. People can become infected with histoplasmosis after inhaling microscopic fungal spores from the air.

Symptoms

Symptoms of a fungal infection are often similar to those of other lung infections. Fever is a common symptom of all fungal infections,  other symptoms can include:

  •  Cough
  •  Night sweats
  • Muscle or joint pain
  •  Weight loss
  • Chest pain and shortness of breath
  • Extreme tiredness or fatigue
  • Headache
  • Neck pain

 Some exceptions can include:

  • Confusion or changes in behavior
  • Vomiting and nausea
  • Photosensitivity
  • Lesions in the mouth and throat
  • Swollen lymph nodes
  • Liver and spleen enlargement

Treatment

In most cases of fungal infections, doctors recur to antifungal medicines. Itraconazole and amphotericin B are used to treat Paracoccidioidomycosis, histoplasmosis, mild to moderate blastomycosis, and severe mycoses of the lungs or infections that have spread to other parts of the body. Another drug often used to treat coccidioidomycosis is trimethoprim/sulfamethoxazole (TMP/SMX), which is also known as co-trimoxazole or Septra. For people with asymptomatic infections or mild to moderate pneumonia, treatment is usually fluconazole. For people with severe lung infections or infections of the central nervous system,  the recommended initial treatment is amphotericin B lipid with flucytosine. 

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